Provider Demographics
NPI:1477602944
Name:LAFRENIERE, SUSAN (ACSW, CGP, CDP, PC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:LAFRENIERE
Suffix:
Gender:F
Credentials:ACSW, CGP, CDP, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 HURON CT
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-1020
Mailing Address - Country:US
Mailing Address - Phone:906-475-5290
Mailing Address - Fax:
Practice Address - Street 1:104 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-4318
Practice Address - Country:US
Practice Address - Phone:906-228-3092
Practice Address - Fax:906-228-3092
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010462401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008967320OtherBCBS
MI0N20440Medicare PIN